Category Archives: health insurance

HHS Publishes Final Rule on ACA Nondiscrimination Provisions

On May 13, the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) published the final rule implementing Section 1557 of the Affordable Care Act (ACA). Section 1557 contains the nondiscrimination provisions of the ACA, which … Continue reading

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Americans Aren’t Prepared to Retire—But Retirement Plan Sponsors Can Nudge Participants in the Right Direction

More Americans in today’s workplace are planning to defer retirement until later in life or to forego retiring at all. In fact, one in five Americans aged 65 and over are currently working due to financial need, the need for … Continue reading

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Modernizing Payment Processing Methods in the Health Care Industry

Today’s health care environment has grown increasingly complex due to compliance requirements that were introduced as part of the Affordable Care Act (ACA). Among other initiatives, the ACA included an industry mandate for the development and use of a HIPAA-compliant Electronic Funds Transfer (EFT) standard for electronic claims payments. The law also increased transparency by implementing Medical Loss Ratio (MLR) requirements that limit a health plan’s ability to pass increased administrative costs on to plan participants. Continue reading

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Referrals Drive Up Hospital Revenue—and Health Care Costs

As the health care field becomes increasingly competitive, hospitals are acquiring independent practitioners in order to increase referrals and revenue. The American Medical Association says that one third of all doctors—mostly primary care practitioners—work for hospitals or for practices wholly or partially owned by hospitals. Continue reading

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Premium Increases Slow, Out-of-Pocket Expenses Rise in 2015

A Kaiser Family Foundation survey found that while premiums have only risen about 4 percent in 2015 on average, deductibles have been rising faster than total health costs—and faster than wages. On average, deductibles have risen about seven times faster than wages, which have stayed relatively flat. Continue reading

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Self-Funding and Reference-Based Pricing: An Overview

As health insurance premiums in the U.S. continue to rise, employers are constantly looking for new ways to reduce employee benefit costs. One solution that many employers are adopting is the use of self-funded health insurance and reference-based pricing. In … Continue reading

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